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Wu Wei Zi: A Great Herb, A Little Caution

By Daniel L.Altschuler, L.Ac, PhD


Wu wei zi (五味子), is one of the most interesting herbs in common use by physicians of Chinese medicine. It would be surprising to find it missing in any Chinese herbal shop. Its listing in the Shennong Bencao Jing(神農本草經) as well as in twelve formulas from the ShanghanZabing Lun(傷寒雜病論) (the combined Shanghan Lun and Jin Gui Yao Lue), firmly anchors wu wei zi as a stalwart componentof the Chinese herbal tradition. Indeed two important formulas include wu weizi: Xiao Qing Long Tang from the Shanghan Za Bing Lun and Sheng Mai Yin (生脈飲<) from Li Dong Yuan's (1180-1251) Nei-WaiShang Bian Huo Lun (內外傷編惑論 Treatise on Differentiating Confusions between Internaland External Damage). Because of the importance of this herb, including its most recent uses as a single herb based on modern biochemical studies, I would like to discuss some of its clinical applications as well as point out some cautions.

The most unique and intriguing aspect of this herb is that it contains all five flavors—sweet, sour, acrid, bitter and salty. This is indicated in its name (wu/five) (wei/flavor) (zi/seed). The Bencao Bei Yao (本草備要) of the Han Dynasty notes that “although all five flavors are present, sour and salty are dominant.” If you are not familiar with this herb, try putting one seed in your mouth. Observe how the flavors emerge one after the other. Again, the Bencao Bei Yao specifies, “The Skin is sweet, the flesh is sour,there is bitterness and acridity in the kernel. [Yet] all [of its parts]contain saltiness.” With such a broad array of flavors, wu wei zi is effective on many fronts, yet the dominance of the sour and salty flavors leads it to act primarily on the kidneys and lungs. This clinically translates into an ability to collect and retain (astringe) fluids.

Sheng Mai Yin (生麥飲) takes advantage of wu wei zi’s ability to reign in fluid which is being lost from sweating, urine or diarrhea in patients who are severely deficient or who are in shock. Wu wei zi works alongside of renshen and mai men dong. Renshen and mai men dong strongly generate life saving qi and fluids, while wu wei zi stops further fluid loss. Laboratory research on wu wei zi has demonstrated a strengthening of heart function by improving diastolic and systolic actions. Systolic contractions are stronger and diastolic expansion is more complete. This formula is famous for potential or acute lifesaving situations, especially when the heart or pulse is the focus ofdeficiency.

In the Shang Han Lun, of all the formulas that contain wu wei zi, Xiao Qing Long Tang (小清龍湯) is likely the most well known. Here, wu weizi helps reabsorb fluid retained in the chest cavity. The classic symptoms of Xiao Qing Long Tang are: “fluid-qi below the heart, nausea, fever, and cough possibly with the presence of diarrhea, eructation, decreased urine output, abdominal bloating or asthmatic breathing.” This pattern shows an external cold pathogen which has moved inward. There is only one external symptom, external heat (fever) while the remaining symptoms are internal cold (fluid accumulation,nausea and cough). A modified Guizhi Tang is used to help release pathogenic cold from both the interior and exterior. Guizhi is helped by mahuang to release and expel the exterior (cold) pathogen while, at the same time, works with the spicy or acrid ganjia which replaces shengjiang of the original Guizhi tang) andxixin, to warm the interior and move fluids. These latter two herbs, ganjiang and xixin, are the notable modifications to Guizhi Tang in the creation of XiaoQing Long Tang and are found with wu wei zi in other Shang Han Lun formulas such as Ling-Gan-Wuweizi-Jiang-Xin Tang (苓甘五味子薑辛湯). Fulingand gancao are added to our herb trio. It is indicated for the internalsymptoms of Xiao Qing Long Tang.

Wu wei zi and ganjiang are similar in temperature but have opposing properties. Wu wei zi acts to retain and collect fluids. It retains lung qi and enhances the kidneys’ ability to receive lung qi (納氣 naqi). While wu wei zi is warm, ganjiang is hot and spicy. Wu wei zi’s nature is stillness; ganjiang’s is movement. Thus ganjiang acts to disperse cold and flush out phlegm and fluids from the lungs while invigorating the spleen and drying up its dampness. Ganjiang’s actions are centered on the spleen or middle jiao while wu wei zi mostly benefits the lungs and kidneys. Thus in this pair of herbs we have the benefit of coordinated dispersing and retaining, opening and collecting.

Xixin, like ganjiang, is dispersing and moving and providesa similar contrasting relationship to wu wei zi. However, unlike ganjiang, xixin mainly works in the same organs as wu wei zi, namely, the lungs and kidneys. Xixin is able to open the lungs and dispel wind which aids the lungs’ function of distributing or dispatching (). In this latter regard, xixin has similar properties as mahuang. Indeed according to classic material medica,they have nearly identical functions. Xixin, like mahuang, also enters the kidneys and, as such, is able to disperse fluids. With this herb pair, then, xixin helps disperse and open the lungs and push out fluids while wu wei zi allows the kidneys to receive lung jing or qi and retain fluids. The common benefit of all three herbs is to warm and disperse cold, remove pathogenic fluids and enhance the function of the lungs, kidneys and spleen.

Other common applications of wu wei zi are diarrhea or dysentery, vaginal discharge, and spermatorrhea. In each case, wu wei zi can be paired with appropriate herbs to enhance its effect. For diarrhea, wu wei zi can be added to Li Zhong Tang (理中湯) in cases where the weakness lies in the spleen. For kidney related diarrhea, Si Shen Wan (四神丸), which already contains wu wei zi, often works when everything else fails. One report from mainland China describes using wu wei zi alone for acute dysentery at 50 grams per day in a boiled decoction. It can be paired with herbs like shanzhuyu, jinyingzi, lianzi, qianshi, jiguanhua and other similar collecting and retaining herbs to help treat cold or deficiency types of urogenital discharges. In many aspects, shanzhuyu clinically is very similar to wu wei zi, with shanzhuyu containing slightly more yin nourishing qualities and being focused more on the liver.

The dosage of wu wei zi generally falls between 3 and 15 grams. Note that when using wu wei zi with ganjiang and xi xin, the dosage should be somewhat even. In the United States, I tend to average 6 to 9 grams; while in Taiwan my average was between 9 and 12 grams. If you are inexperienced with these herbs, it is best to initially dose at 3 to 6 grams and slowly increase until you find a comfortable and effective range. This is especially true for xi xin, whose dose and safety is currently a controversial topic. As always, the effective and safe dose will vary dependant on the individual patient’s particular and systemic condition, your local climate and season, and other environmental factors.


A few cautionary notes:

I would like to address two problems regarding common applications of wu wei zi in the modern clinic. The first concerns its use for coughs, such as its function in Xiao Qing Long Tang. The second concerns its ability to reduce liver enzymes in viral hepatitis.

When used for coughs, we must remember that it is not indicated for all coughs. First, classic texts warn us not to use wu wei zi for full-heat conditions or for new coughs. If used for new coughs, it will not only be ineffective, but will make the condition even more problematic to cure.

Also note that most classical formulas constructed for coughs do not contain wu wei zi. It is absent in such prominent formulas as Mahuang Tang (麻黃湯),Guizhi Tang (桂枝湯)(or its modification for asthmatic coughs Guizhi jia Xingzi Houpo Tang 桂枝加杏子厚朴湯),Ma-Xing-Gan-Shi Tang (麻杏甘石湯), or Warm Disease formulas such as Beimu Gualou San (貝母瓜蔞散), Xing SuSan (杏蘇散)and so forth. Even Zhi Sou San (止嗽散) leaves it out. Remember that the ‘internal’ symptoms of Xiao Qing Long Tang are signs of fluid retention in the chest region. Fluid in the pleural space (pleurisy, pleural effusion), in the pericardium (pericardial effusion), and lungs (pneumonia, walking pneumonia, COPD) are perhaps the most common ‘diseases’ which directly correlate to the set of symptoms listed under Xiao Qing Long Tang. Fluid or phlegm coughed upshould tend to be clear or thin rather than thick and yellow, though clinically the latter is not an absolute counterindication for wu wei zi.

Further, the 19th century physician, Zhang Xi Chun (張錫純, 1860-1933), discusses the use of wu wei zi with ganjiang and xixin in a cautionary note. He feels that wu wei zi needs dispersing herbs to prevent retention of pathogenic qi. In other words, the retention and dispersing not only comprehensively take care of the pathogenic fluids but they also act as a mutual counterbalance so that neither causes further problems. In this regard, Zhang Xi Chun further teaches us that wu wei zi should be crushed“so that the acridity (dispersing function) in its core can aid the sour (retaining function) of the outer layer to prevent distention and bloating.”

My experience in using wu wei zi for coughs is that imprudent or excessive application can dry out phlegm too quickly. If the phlegm tends to be viscous or the cough in general is dry or non-productive, it is beneficial to add in a nourishing herb to help moisten and loosen the congestion. Personal favorites are xuanshen (kidney-lungs), bei shashen (spleen-lungs), and baibu. Other herbs used for this purpose include gualou, dihuang, and danggui.

Another cautionary item I would like to address is the recent use of wu wei zi for viral hepatitis. Wu wei zi has been shown in both the laboratory and clinic to dramatically reduce liver ALT enzyme count. But great caution should be used in this situation. Wu wei zi does not clear the heat of the liver. In other words, it is not ‘curing’ the hepatitis. It is only lowering ALT. To be sure, this is extremely useful when ALT and AST are in the 1000 to 2000 unit range and the patient is in danger of hepatic coma or organ shut down. But after wu wei zi has lowered the enzyme count, there will often be a rebound effect that can be quite dangerous. One can liken this phenomenon to suppressing flames while neglecting the red hot embers. When using wu wei zi for hepatitis, unless you have ample clinical experience, it is best used as a supplementary herb (if at all), not the main herb. Or you may wish to substitute another herb effective for liver disease, such as chenpi, huzhang, shanzha, etc. that avoids this problem. And, after liver function has returned to reasonable or even normal levels (say, ALT and AST under 70 or 80), make sure that the patient is given long term follow up herbal care with careful attention to blood testing until determining that the condition is stable.

Finally, wu wei zi has received a lot of attention recently in the biopharmaceutical industry and has been marketed as a tonic with wide ranging health benefits, including hepatoprotectivity, boosting sexual functionand fluids, and other tonic qualities. These are attributed to lignans, adaptogenic and other phytochemicals found to be contained within wu wei zi through laboratory research. Much of this research confirms what has already been recorded in the classics. Yet we must remember that wu wei zi, like any herb has a multitude of functions and must be used by matching its qualities—temperature, nature, flavor—with the specific symptoms and general constitution of the individual patient. The doctor of Chinese medicine should be guided but not misled by individual laboratory reports and certainly not marketing advertisements. As mentioned above, inappropriate use may cause a variety of unwanted effects.

Nevertheless, wu wei zi is a great herb with broad applications too numerous to mention in this brief report. With only a little insight and caution, it can be used alone or in combination with few serious side effects.

 


 

The above article text was printed with permission from Daniel Altschuler, Copyright 2008. Photos are credited as follows (from top to bottom):
Photo 1: Li Dong Yuan; public domain
Photo 2-3: Wu wei zi berries and tea; author Micleu; permission Jade Institute
Photo 4: Schisandra cinensis; author Doronenk; permission GFDL; 2007

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